Registration – Living in Harmony with Spiritual Energy Program Registration Living in Harmony with Spiritual Energy Living in Harmony with Spiritual Energy Contact Information Full Name * Email Address * Phone Number * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Waiver Please review and sign the following waiver: Any and all aspects of this mentoring are undertaken voluntarily on your part. This mentoring is not meant as therapy or as a replacement for any other professional service that you would engage for your physical or mental health. The waiver is your acknowledgement that the Personal Transformation and Courage Institute is released from any liability related to your participation in this mentoring. The undersigned knowingly releases and holds harmless the Personal Transformation and Courage Institute and its agents from any and all claims, suits, proceedings, costs, losses, expenses, damages, and liabilities, including but not limited to attorney’s fees and court costs, caused by and arising out of, or in connection with his/her participating in this mentoring. E-Signature * Payment Tuition is on a sliding scale. The recommended amount for this program is from $595 to $795. However, we welcome anyone at any amount who has a genuine interest in working with this material. Each participant is asked to decide at registration what one's personal financial situation at this time allows. Our intention is to make this program widely available to all who would like to be involved, while at the same time maintaining PTCI's own financial balance. You will see on the registration page that there is a place for you to enter the tuition amount that is possible for you. Payment Amount * Payment Type Please indicate how you will be paying for this course: PayPal / Credit Card Check To pay via PayPal account or credit card select this option and then click the "REGISTER" button below and complete the payment process on PayPal's secure website. Select the "Pay with Debit or Credit Card" option on the first page to use your card and proceed without creating a PayPal account. Please make your check payable to the Personal Transformation and Courage Institute. Please use check's memo line to indicate which course you are paying for. Mail check to: PTCI P.O.Box 914 Virginia Beach, VA 23451 If you are human, leave this field blank.